Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 227588 | NY |
NPI | 1649284431 |
---|---|
Provider Name | Mr. Carlos Augusto Montenegro |
First Address | Ozone Park, NY 11416-2515 |
Second Address | Brooklyn, NY 11207-4101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |